Ankylosing spondylitis (AS) is an inflammatory arthritis that affects parts of the spinal joints, ligaments and the sacroiliac joints. This causes pain and stiffness in the neck and lower back and buttocks. This condition can be severe, with around 1 in 10 people at risk of long-term disability including uveitis, osteoporosis, spinal fractures and cardio vascular disease. AS is around three times more common in men than in women and can develop at any time from teenage years onwards, usually occurring between 15 and 35 years of age.
It is not known exactly what causes the AS to develop, but there is thought to be a link with a particular gene known as HLA-B27. About 8 in 100 people in the general population have the HLA-B27, with 97% of people with AS having it so there seems to be strong correlation. However having the gene doesn’t mean you will definitely get AS as there must be an environmental trigger. What seems to happen in AS is that an environmental trigger causes the loss of immunological tolerance and molecular mimicry. This is where the chemicals in environment (be it food, metabolites of bacteria, toxins, etc…) resemble the amino acid structure of the body tissues. This causes immune system to see the genetic structure of your own spine, spinal ligaments and sacroiliac joints as the same as the environmental trigger and mounts an immune response against them creating pain and inflammation.
The exact environmental trigger are unknown and could be toxins, viruses, or bacteria, however there is some strong belief that AS is a reactive arthritis due to klebsiella bacteria infection in the bowels. Klebsiella colonises the ascending colon and if it gets into the blood stream it leads to molecular mimicry, loss of immunological tolerance and the development of AS.
Regardless of the cause of AS you will be diagnosed based of the following criteria:
- X-ray that shows sacroiliitis
- Three months of lower back pain that gets better with exercise
- Limited movement in the lumbar spine
- Limited chest expansion
- HLA-B27 gene presence
Conventional treatment for AS includes the prescription of painkillers, bisphosphonate, disease-modifying anti-rheumatic drugs (DMARDs) and steroids. Your GP will probably refer you for some physiotherapy and advise you to give up smoking, lose weight and exercise more.
Nutritional management of AS
Eating an anti-inflammatory diet is the first line nutritional management strategy. This includes balancing meat and dairy intake with oily fish intake. Eating more vegetables and some fruit and reducing grains and including specific foods in the diet such as ginger, garlic and turmeric. Taking an omega 3 supplement may also be beneficial.
As there may be a klebsiella infection present in people with AS, it seems that killing off the bacteria would be pertinent. The half life of klebsiella bacteria is 2 weeks, after this new bacteria must be present so to kill it you must starve it. Bacteria only grow on carbohydrates so eating a low starch diet would help. It would also make sense to eat foods that have naturally high amount of friendly bacteria at the same time such as plain yoghurt or homemade yoghurt, sauerkraut and kefir. Eating foods called prebiotics such as onions, leeks, garlic, Jerusalem Artichokes and bananas can also help. It may also be worth taking probiotics powders and capsules. London nutritionist Steve Hines has help people manage their AS with a low starch diet.
